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Acoustic neurinomas - Symptoms and treatment

They are benign tumors developed from the acoustic nerve at the ponto-cerebellar angle.

The diagnosis of acoustic neuroma

Of very slow evolution, this tumor reaches the adult after 30 years. A Recklinghausen disease is sometimes associated.

The treatment of acoustic neuroma

The neurinoma of the acoustic or vestibular schwannoma most often manifests itself first of all by deafness of perception, progressive unilateral with vestibular hyporeflexia, buzzing of ears (tinnitus).

The radiographs of the skull (incidence called "rocks in the orbits") show an enlargement of the internal auditory canal, the computed tomography (scanner) confirms the diagnosis, as well as the audiogram and the auditory evoked potentials. However, currently the most useful diagnostic test is MRI to detect very small neurinomas.

1. Radiological surveillance may be proposed for elderly patients or those with very small neuroma. An annual MRI in these cases is recommended with, of course, symptom monitoring.

2. Radiotherapy under stereotactic conditions, also called radiosurgery (CyberKnife), is increasingly used to treat small neurinomas. This technique allows a tumor stability of more than 90%.

3. However, the CyberKnife park is still limited and therefore surgical excision is still often practiced. There are three different surgical modalities chosen by specialists depending on the situation of the tumor, the age of the patient, or the degree of preservation of the hearing.

The risk of surgery is a lesion of the acoustic nerve (VIII), and sometimes of the VII (facial nerve), causing peripheral facial paralysis.

Later, the signs complement each other with the involvement of the trigeminal nerve (V) and the facial nerve (peripheral VII), a homolateral cerebellar syndrome, and involvement of the long ways. At this stage, surgery is more delicate.

Sources

Site of the Hôpital Lariboisière, Paris. Document Acoustic Neuroma updated on 29/09/2014